Towards the idea of ‘clinical capital’: A longitudinal study exploring nurses' dispositions and workplace manifestations in an Australian intensive care unit

Objective: To explore the concept of ‘capital’ through the study of successive interventions and outcomes (patient and staff) in a quaternity intensive care unit (ICU) across a 5-year time frame. Design: A longitudinal intrinsic single site, a survey study was designed. The concept of ‘capital’ was explored through an adopted interpretive approach that involved understanding meanings from different sources, for example, discussions at compassion cafés, follow-up from staff-initiated activities, informal responses to organizational imperatives external to the unit (i.e. staff reductions and resource constraints), alongside empirical data about workplace climate and patient incidents. Setting: A single ICU employing approximately 220 registered nurses at a quaternary hospital in Queensland, Australia. Participants: All nurses employed in the ICU at the time of compassion cafes participated in providing feedback to inform successive activities. All nurses in the unit had equal opportunity to complete surveys, participate in subsequent unit-based sessions, take-up options; and all nurses had a responsibility to complete incident data. Results: Survey and incident data from 2015 to 2019 identify the complexity of workplace environments. Between 35% and 45% of nurses consistently completed the survey. Activities based on staff requests initially improved incident data but did not impact the work environment; negative perceptions of the work environment at the endpoint (2019) were associated with external factors. Conclusion: Quality care environments are labile; sensitive to both unit activity and external organization directives (namely staff reductions). Quality care can be sustained in adverse situations with increased nurse engagement in patient care dynamics in the short term. Impact: This study articulates a previously unidentified concept, ‘clinical capital’. Activities facilitating nurse engagement in broad care dynamics gave rise to a more robust climate than just focusing on social and psychological well-being activities for nurses. Participation in issues of concern about patient care can promote resilience to short term fluctuations.